吴于青+梁秀丽+廖永美

【摘要】 目的：探索超短程化疗方案用于治疗初次复治肺结核的临床效果，制定出初次复治肺结核化学治疗新方案。方法：选择2009年9月-2010年8月本院诊治的240例痰涂阳初次复治肺结核患者，随机分成标准方案组（A组）、氧氟沙星组（B组）、左氧氟沙星组（C组）和超短程化疗组（D组），分别给予2SHREZ/6HRE、2OfxPaREZ/6OfxPaR、2LfxPaREZ/6LfxPaR和5MfxPaRfbEZ的治疗方案。比较四组患者临床疗效、痰菌转阴率、病灶吸收、空洞闭合情况。结果：治疗2个月时，四组痰菌转阴率比较，差异均无统计学意义（P>0.05）；治疗结束时，B组、C组及D组的痰菌阴转率、病灶吸收显吸率、空洞闭合率均显著高于A组，差异均有统计学意义（P<0.05），B组、C组及D组两两比较，差异均无统计学意义（P>0.05）。四组患者治愈和失败情况比较，差异均无统计学意义（P>0.05）。结论：5MfxPaRfbEZ超短程化疗方案治疗初次复治肺结核具有良好效果，具有较好的临床应用价值。

【关键词】 初次复治肺结核； 化学治疗； 氟喹诺酮类药物； 治疗新方案

【Abstract】 Objective：To explore the clinical effect of ultra short course chemotherapy regimen in first time retreatment of pulmonary tuberculosis，develop a new chemical treatment plan for the first time retreatment of pulmonary tuberculosis.Method：240 cases of primary pulmonary tuberculosis with smear positive sputum smear，who were diagnosed and treated in our hospital from September 2009 to August 2010，they were randomly divided into standard group（group A），Ofloxacin group（group B） and Levofloxacin group（group C） and ultra short course chemotherapy group（group D），and they were given 2SHREZ/6HRE，2OfxPaREZ/6OfxPaR，2LfxPaREZ/6LfxPaR and 5MfxPaRfbEZ.The clinical curative effect，the sputum negative conversion rate，focus absorption and cavity closure of the four groups were compared.Result：After 2 months of treatment，comparison of the sputum negative conversion rate of the four groups， there were no significant differences（P>0.05）.At the end of treatment，the sputum negative conversion rate，focus absorption and cavity closure rate significant absorption rate of group B，C and D were significantly higher than that in A group，the differences were statistically significant（P<0.05）.B group，C group and D group compared with each other，the differences were not statistically significant （P>0.05）.There were no significant differences between the four groups in the cases of cure and failure（P>0.05）.Conclusion：5MfxPaRfbEZ ultra short course chemotherapy has good curative effect in the first time retreatment of pulmonary tuberculosis，and has good clinical application value.

【Key words】 First time retreatment of pulmonary tuberculosis； Chemotherapy； Fluoroquinolones； New treatment plan

First-authors address：Jiangxi Chest Hospital，Nanchang 330006，China

doi：10.3969/j.issn.1674-4985.2016.36.013

在嚴格的化疗管理基础上采用标准初治肺结核化疗方案能使接近90%的初治肺结核患者受益[1-2]。但复治肺结核在治疗方案选择和确定上则较为复杂和困难，期治疗效果往往较差，此类患者构成我国耐药结核病的主体，特别在多耐药结核病（polydrug-resistant tuberculosis，PDR-TB）、耐多药结核病（Multi-drug resistant tuberculosis，MDR-TB）及严重耐药结核病（Extensive drug resistant tuberculosis，XDR-TB）最为常见[3-6]。因此，制定合理的复治肺结核治疗方案，能够有效控制耐药结核在我国以及全球的传播和流行[7]。文献[8]报道称，初治肺结核患者经规则治疗失败后再采用标准化方案治疗，其治疗有效率显著降低，治愈率仅53.6%。故对复治肺结核患者进行初次治疗时，应选择与患者复治类型和药敏情况相对应的化疗方案，能够有效提高治疗效果，减少耐药性的发生[9-10]。本研究针……